This dissertation is dedicated. My wife, Marie Chantal Mukaneza, and. To my children.

Transcription

1 This dissertation is dedicated To My wife, Marie Chantal Mukaneza, and To my children. i

2 DECLARATION CANDIDATE This dissertation is my original work and has not been presented for a degree, or other academic award, in any other University or institution of higher learning. Signed 02/04/2012: Dr Augustin SENDEGEYA MBChB (Rwanda) SUPERVISOR This dissertation is submitted as a final copy with my approval as the University s Academic and Clinical Supervisor. Signed: Adjunct Professor Pradip C. Modi Academic Head Division: Otorhinolaryngology-Head Neck Surgery Department of Neurosciences School of Clinical Medicine Faculty of Health Sciences University of the Witwatersrand ii

3 CO-SUPERVISOR This dissertation is submitted as a final copy with my approval as the Co-Supervisor Signed: Dr Marco Torres-Holmes Lecturer & Clinical Specialist Division of Otorhinolaryngology-Head Neck Surgery Department of Neurosciences School of Clinical Medicine Faculty of Health Sciences University of the Witwatersrand iii

4 ACKNOWLEDGEMENTS I wish to express my gratitude to all the following: PROFESSOR P.C. MODI, my Supervisor, Clinical and Academic Head for his guidance, support, and input throughout the preparation and execution of this study and for his invaluable criticism in the final preparation of this dissertation. Dr MARCO TORRES-HOLMES, my co-supervisor, for his guidance and invaluable criticism during the execution of this study. All the members of the Academic Peer Review Committee of the Department of Neurosciences for their guidance and valuable criticisms. The Nursing and Clerical Staff of the: ENT Operating Theatre ENT Ward National Health Laboratory Services At the Charlotte Maxeke Johannesburg Academic Hospital, the Chris Hani Baragwanath Hospital; and at the Helen Joseph Hospital for their support in assisting with the sourcing of all the relevant data. My wife Marie Chantal and children for their patience, encouragement and deep understanding throughout the process of this study. iv

5 TABLE OF C ONTENTS Title Declaration ii Acknowledgement iv List of figures vi List of tables vii Summary viii Introduction 1 Literature review 4 Aims and objectives 7 Material and methods 8 Results 12 Discussion 24 Conclusions 28 References 29 v

6 LIST OF FIGURES Page Figure 1 Age distribution 12 Figure 2 Gender distribution 13 Figure 3 Patients distribution between the various hospitals 13 Figure 4 Distribution of patients who had parotid surgery between years 2006 to Figure 5 Pain 16 Figure 6 Consistency 16 Figure7 Tenderness 17 Figure 8 Facial weakness 17 Figure 9 Distribution malignant versus benign parotid tumours 19 Figure 10 Distribution of benign tumours 20 Figure 11 Distribution of malignant tumours 20 vi

7 L IST OF T AB LE S : P ag e 1. Demographic characteristics by Gender Table summarizing Clinical Signs Histological characteristics by Gender Difference between Benign and Malignant Neoplasm s with reference to Clinical Signs Difference between Benign and Malignant Neoplasm s with reference to Gender and Age. 23 vii

8 S UM M ARY Background: Parotid tumours constitute a highly heterogeneous group. The pattern of parotid tumours in South Africa has not been extensively reported. Purpose: The aim of this study was to describe and analyse the clinical presentation and the histopathology of the parotid tumours in the Division of Otorhinolaryngology and Head and Neck Surgery at the academic hospitals of the University of Witwatersrand. Methods: We retrospectively reviewed the medical records of 71 patients who underwent parotid surgery for parotid tumours from January 2006 to December Data including age, gender, clinical signs, symptoms and histological findings were collected. Results: Of the 71 patients, 46 (64.78%) had benign tumours and 25 (35.22%) had malignant tumours. The most common benign tumour was pleomorphic adenoma (76.09%) and the most common malignant tumour was mucoepidermoid carcinoma (52%). The clinical findings did carry a significant importance in the malignant-benign differentiation especially the presence of pain (p=0.002) and facial weakness (p=0.003). Conclusion: Pleomorphic adenoma was the commonest benign parotid tumour and mucoepidermoid carcinoma was the most malignant tumour. The malignant-benign ratio was comparable to other African series. The presenting symptoms of pain and facial weakness were found to be strong indicators of malignant disease. viii